Radiology Coding Alert

Don't write off the time that your physician spends performing additional studies

If your physician performs a radiology service and then calls the patient back for follow-up studies, should you combine the two studies into one code, or code each study separately? The answer depends on why the radiologist performed the follow-
up studies.
 
Example: Suppose a gastroenterologist orders a pelvic computed tomography (CT) scan without contrast. Your radiologist performs the scan without contrast. He interprets the report and shares the results with the gastroenterologist, who then orders a scan with contrast. The radiologist calls the patient and asks her to return to the office so he can perform additional pelvic CT slices - this time with contrast. Which of the following coding scenarios should you choose?
 
A. Report CPT 72192 (Computed tomography, pelvis; without contrast material) for the first visit and CPT 72193 (...with contrast material[s]) for the second visit, or
 
B. Report one unit of 72194 (... without contrast material, followed by contrast material[s] and further sections) to cover all of the physician's work for both visits.

2 Separate Orders Report 2 Codes

Coding solution: Because the ordering physician originally requested a non-contrast scan, you should choose coding option A, says Linda Thornton, CPC, billing supervisor at St. Louis University's SLUCare, a healthcare service provider. "We would just read the first exam 'without' contrast for that date of service, then we would bill for the 'with contrast' when the patient returns."

Radiologist's Mistake Report 1 Code

Suppose, however, that the gastroenterologist orders a pelvic CT scan without contrast, followed by a study with contrast on the same order. Your radiologist accidentally releases the patient after he performs the without-contrast CT scan. He then calls the patient and asks her to return for the same scan with contrast.
 
Solution: In this case, you should choose coding option B, says Carrie Caldewey, RCC, CPC, coding specialist at Redwood Regional Medical Group in Santa Rosa, Calif. "Usually, on the second exam, if the need for more/different images is our fault (due to a misread order, or if we took non-diagnostic images first), the physician will note that in the second report and there is no additional charge for the service. If it's a contrast issue, if the charge has not been posted, we'll recode for the correct exam as one complete exam. If it has been posted, we reverse the original charge, and then charge out the complete exam."
 
If you bill 72194 instead of reporting each service separately, your physician should document why he performed the "with-contrast" slices and the "without- contrast" slices on separate dates.

If Patient Never Returns, Don't Append -52

Let's say your radiologist accidentally forgets to perform the "with-contrast" slices, and asks the patient to come back to your office to obtain the additional studies - but the patient never returns. Should you bill the study that the gastroenterologist ordered (72194) with modifier -52 (Reduced services) appended, or should you bill only for the "without-contrast" slices (72192)?
 
"You'd really have to just charge the 'without- contrast' code (72192)," Caldewey says. "It follows the CPT guidelines of the actual code for the procedure, rather than the 'closest code.' Since there's an actual code for what the radiologist was able to perform, that would be the most appropriate one to use."
 
You should therefore report only 72192 for the radiologist's "without-contrast" study.